- The awake surgery is done in nearly 2% of brain tumour patients who are adults, but is rare in children
- The surgery was performed in SIMS Hospital in Chennai
- The girl was discharged from hospital two days after the surgery
When surgeons were removing a tumour from the most sensitive
part of a 10-year-old girl's brain in a Chennai hospital last Wednesday, she
was playing her favourite game on her uncle's cellphone. By staying awake,
talking and moving her limbs, the girl gave her doctors the confidence that
they were on the right track.
Nandini, a Class V student and a Bharatanatyam dancer, was
brought to SIMS Hospital with complaints of sudden onset of fits. Brain scan
revealed that she had a tumour in an important area of brain which controls the
movement of the left half of the body, including face, hand and leg.
SIMS Hospital neurosurgeon Dr Roopesh Kumar told her parents
that if the tumour grew further, it could cause paralysis or could be fatal.
In a conventional procedure, called craniotomy, a disc of
bone is removed from the skull using special tools to give surgeons access to
the brain when the patient is unconscious.
"I did not want to go in for the conventional method of
removing the tumour. It was in the sensitive part of the brain and if we
accidentally touched a wrong nerve, it could cause complete paralysis of left
half of her body," he said.
The doctors decided to do the same procedure by keeping the
patient awake and alert. "That way, I will know exactly which areas of
your brain control those functions and avoid them," Dr Kumar said.
The awake surgery is done in nearly 2% of brain tumour
patients who are adults, but is rare in children, said SIMS Institute of
Neurosciences director Dr Suresh Bapu. The patients feel no pain during the
surgery since the neurons in the brain don't have pain receptors.
While her parents were initially hesitant, the surgeons took
the help of the patient's uncle in Puducherry, who is a doctor, to convince
them.
"I was in the theatre when the removed the tumour.
Nandini was playing Candy Crush on my cellphone. She moved her hands and legs
when we asked her to do so. The surgeon had to make sure that the point he is
operating on does not affect her mobility. She was brave," said her uncle.
The family told doctors that they were worried about the
post-surgical stress but doctors said studies from medical literature showed
that such surgeries were safe in children.
"It's rare in children, but we did have enough
evidence," he said.
In June 2017, World Neurosurgery, a medical journal,
published the psychiatric and psychological impact of the awake brain tumour
surgeries in children after following up on case sheets of seven children --
aged between 8 and 16 -- post surgery.
The results showed that none of the children had initial
psychiatric problems. While parents experienced anxiety, no child showed signs
of post-traumatic stress disorder.
Such studies gave confidence to the entire team, said neuro
anesthetist Dr Sudhakar Subramaniam, who stood by the patient side during the
three and a half hour surgery.
At the end of the procedure, she was moving her hands and
legs. She was discharged from hospital on Friday, two days after the surgery.
Nandini told the doctors that she would resume Bharatanatyam
practice in a few days.
